Good Vibrations

Can doses of vibration improve health and performance? Jennifer Trueland debunks some myths.

At the end of a hard day’s rehearsing and before an evening performance, dancers at the Royal Ballet can often be found lying down with their legs on a vibrating plate. ‘Rehearsals can be from 10.30am to 5.30pm, then the performance is at 7.30pm,’ explains Royal Ballet physio Daryl Martin. ‘Ballet is hard on the calves in particular, because they spend so much time en pointe. So that’s a favourite massage.’ The physio department in Covent Garden is far from unusual in utilising whole body vibration therapy. Over the last five years, use of WBV has grown rapidly in gyms, physiotherapy clinics and in the home. But is it actually doing any good or is it merely the latest must-have tool, which will shortly be consigned to the rubbish heap of outmoded exercise devices? Indeed, far from benefiting users, is it actually harmful? Even devotees of WBV admit there is a real research deficit. At first glance there is a considerable literature, covering its use in a variety of settings, including rthopaedics, neurology and sports medicine. But most of these studies are small scale and far from conclusive. There is also anecdotal evidence aplenty, with the manufacturers of the various vibrating plates quoting testimonials from users who say it has, for example, improved the symptoms of multiple sclerosis.  Marco Cardinale, head of science and research at the British Olympic Association is the author of many studies into WBV. He believes it is a valuable tool for a number of purposes, including improving fitness and rehabilitation. But Dr Cardinale has major concerns about the way it is marketed and used. ‘It’s really kicked off in the last few years and there are around 170 small companies producing vibrating plates. The problem is that they are all copying each other, more or less, and are not investing seriously in research,’ he says. ‘Many are making claims which are completely unsubstantiated, promising that it will reduce body fat, improve sexual activity and get rid of cellulite, when it just won’t. The risk is that it becomes the latest fad.’  There is a paucity of research in the field, he says. ‘All the studies have small sample sizes. Ten years ago when I was applying for research grants people laughed at me, they thought I was crazy. It’s improving now but there is still no money for large-scale studies.’ WBV AIDS WARM-UP What he and others have found is that using WBV can help athletes warm up and cool down, probably because it excites the neuromuscular system. ‘It’s preparing the body for something to happen,’ he explains, adding that by facilitating nerve impulses, it improves blood flow and increases muscle temperature. Longer term, WBV appears to improve bone metabolism, which is why it is of particular interest to NASA and the European Space Agency. Astronauts lose bone mass in space and, on their return, WBV has been used to help them recover. Again this has given rise to myths. ‘I’ve seen it claimed that Russian astronauts use it in flight, but you couldn’t have a vibrating plate in a space ship – it would destroy the mechanics of the ship,’ Dr Cardinale explains. He believes where WBV comes into its own is with the less fit, rather than athletes. ‘If you’re old, or injured and needing rehab, then you might not want to go to a gym and be surrounded by people in leotards. But you can do this in a small studio or even at home. And you might not want to lift weights – and you need to be trained to do that properly – but you can stand on the plate and squat slightly and it will have an effect.’ He believes WBV can help older patients to regain enough strength to keep them independent, for example. And it’s good for improving strength in those who wouldn’t otherwise be taking exercise. ‘It’s a useful tool, but people should be aware there are risks,’ he says. ‘Some people do exercises lying on the plate and they shouldn’t – it could cause damage to the spine, retinal detachment or migraine.  ‘Some of us are thinking of creating a position statement on WBV. It’s worrying it’s in gyms and people’s houses but there is no real safe guidance out there.’ MULTIPLE SCLEROSIS Lorna Paul, reader in nursing and healthcare at Glasgow University and a physiotherapist by background, is trying to address the WBV research deficit. She and colleagues at the Revive MS Centre in Glasgow have just completed a small-scale study, funded by the MS Trust, into the use of WBV in people with this condition. ‘As usual the study has come up with more questions than answers,’ Dr Paul says. There’s an awful lot of research needing to be done.’ The study compared the effects of exercise using WBV with exercise alone. Fortunately it did not demonstrate that WBV caused any harm to the patients, but the evidence of benefit was less clear cut. The full results should be published shortly.   Françoise Schyns, physiotherapist coordinator at Revive, says her patients reacted positively to WBV, on the whole. ‘As a clinician, if your patient tells you “I feel better”, then you feel you’re achieving your goal and you have to take them at face value. But it’s different when you’re looking for objective outcomes.’ A ‘BIT OF A FAD’? The research came about after a patient raised money to buy a vibrating plate for Revive. ‘My gut feeling is that if research shows the effects are as good as, or better than, weight training then it could be good for people who can’t do weight training. At the moment, though, I think it could be a bit of a fad.’ There are concerns for neurology patients as some cannot, because of their disability, get into the right position on the plate to do the exercises. There is also the issue of fatigue – particularly for MS patients. ‘You have to balance it up. You might improve someone’s muscle strength but then they are too tired to drive home.’ Jane Petty, national physiotherapy lead with the MS Society, is not convinced by WBV. Anecdotally, she says, some patients with increased ‘tone’ in their legs have found it worsened with WBV, while others have been encouraged to stand on plates in inappropriate positions. ‘This is a vulnerable population and I worry that they are being persuaded to part with a lot of money in the hope that it will improve their MS. It won’t,’ she said.  Cherry Kilbride, co-chair of the Association of Chartered Physiotherapists in Neurology, says she is not aware of WBV being widely used in the NHS. ‘I would class WBV as a novel intervention that is still being evaluated for more widespread clinical use. The latest draft stroke guidelines note it has been subject to some evaluation work but should not be used routinely outside the context of research,’ says Dr Kilbride. USEFUL REHAB WBV is more commonly used in sports physiotherapy, says Stephen Mutch, a physiotherapist at Space (Sports Physiotherapy Advanced Centre of Excellence) in Edinburgh, although he adds it is certainly not universally popular. Mr Mutch, who is vice chair of the Association of Chartered Physiotherapists in Sports Medicine, uses WBV extensively in his work, which includes looking after the Scotland rugby team. He and his colleagues find it particularly useful in rehabilitating patients with bone injury, such as microfractures, and also for anterior cruciate ligament injuries. ‘The platform is an instant way of challenging the body,’ he says, comparing it to other equipment such as wobble boards. ‘The orthopaedic surgeon who works with us has found, when revisiting injuries, that the changes under arthroscopic conditions are quite remarkable.’  Scotland’s rugby team finds WBV such a useful aid that it transported a plate across to France for the World Cup there last year. As well as doing strength training, such as weights and squats, the players use the massage functions as part of their ‘warm down’ after a match. ‘It reduces the lactic concentrations,’ Mr Mutch says.  Although it has some benefit in strength improvement, he believes it is more useful in rehabilitation. ‘I went on a fact-finding trip to the United States and visited some big sporting teams, and they were using it less than I’d anticipated. I’d say use has really dropped off a bit.’ At the Royal Ballet, Daryl Martin introduced WBV after learning about it in his previous role, working at the British Olympic Association with Dr Cardinale. Around a third of the dancers use it as part of their daily warm-up routine, he says, while around a half use it as part of physiotherapy sessions. ‘Subjectively, I believe it helps prepare dancers for practice and that it helps prevent injury. There is evidence it pre-activates muscles – jump heights improve after WBV because the muscles are “switched on”.’  It’s used in three main areas: stretching, where the dancers can get a fuller stretch than on the floor (the vibration, Mr Martin suggests, desensitises the muscle that would normally ‘stop’ the stretch); strengthening, particularly after exercise such as stress fractures of the foot, and finally, massage. HOW MUCH IS TOO MUCH? There are, of course, a number of conditions associated with receiving too high levels of vibration – perhaps most famously vibration white finger, an industrial injury triggered by overuse of hand-held vibrating machinery. The manufacturers of vibrating plates are scrupulous about pointing out that some people, for example, those with cardiovascular diseases or severe migraine sufferers, should not use the plates. But is this enough? Again, there is little evidence.  Issues around safety are of particular concern to Richard Collier, a senior lecturer in physiotherapy at Southampton University, who is conducting research into the effects of random and shock vibration on people who travel at high speed in boats. ‘I started with an interest in the use of WBV as a clinical tool, but it is very difficult to get ethical approval to conduct research in this field,’ he says. The issue centres on the amount of vibration it is considered safe for people to be exposed to, measured as the vibration dose value. There are British, European and international safe exposure limits on the amount of vibration it is considered safe to be exposed to regularly, which are related to occupation situations. In other words, they protect people who encounter vibration in a work situation, such as driving or operating drills.  Using a commercial WBV plate at even its lowest setting could breach occupational safety standards on vibration dose value within a few seconds, but most users could be spending much longer than this. ‘It concerns me that there isn’t well-funded and appropriately conducted research looking at the pros and cons in well-controlled trials,’ says Mr Collier.  ‘I’d like to see research into appropriate doses and the effects in the short, medium and long-term, and how we could use WBV within the current legislative context. I think WBV might turn out to be a useful clinical tool, but only once we fully understand how it works and how to use it safely with patients.’  The challenge is on: do the research. Then we’ll know whether shimmying and shaking is therapeutic. FL The amazing cure-all Vibration therapy has a long and varied history and has, in its different guises, been employed by doctors, housewives, astronauts and athletes. The late 19th century first saw a boom in vibration therapy, as advances in technology led to the creation of various fantastical devices for clinical and home use.   Vibrating devices were hailed as curing a range of ills, including relief of muscle pain, hysteria, infertility, toning up cardiac muscles and relieving pain, as well as providing general relaxation. They include a vibratory fork for Boudet of Paris, used for anaesthesia and neuralgia, a vibratory cap and a vibrating table, and the first electromechanical vibrator (invented in the 1880s by British doctor Joseph Mortimer Granville).  More recently, vibration therapy was used in the 1960s by Soviet cosmonauts (on the ground) to counteract the bone and muscle degeneration caused by zero gravity. In the late 1990s, vibration therapy techniques started being used by Olympic trainers and are now widely used by top athletes and elite teams. ‘My muscles ached as though I’d done an hour-long workout’ It’s supposed to help you lose weight, banish cellulite and improve your sex life. Madonna and Sting are reputedly fans.  But when I was asked to road test vibration therapy I had a rather less glamorous image in mind. Specifically, my thoughts were of 1970s adverts for so-called slimming belts that claimed to vibrate the flab away.   And in any case, how could something work if it didn’t hurt?  Refreshingly, studioEH1, the Edinburgh Power Plate studio, makes few dramatic claims. You will see results, its literature says, including increased muscle strength and flexibility, improved range of motion, increased bone density and yes, decreased cellulite, but only after putting in some effort.   So much for dreams of standing on a plate and letting the fat wobble off.  The studio had been open only a few weeks when I had my sessions, which are all instructor-controlled, in my case by Helen Maclennan, a director of the business. Ms Maclennan, a former club and county level squash player, became enthused about Power Plate through a friend, international squash champion Peter Nicol, who has a studio in London. Alarmingly, there are pictures of Mr Nicol doing weird flexible things with Power Plate in the studio. Fortunately Ms Maclennan doesn’t expect me to hold those poses immediately. After the usual sort of induction questionnaire about injuries and more, it’s time to step on the plate.  And it feels very strange. My friend Nikki, in a gesture of solidarity, had popped on the plate at her gym the evening before and said she ‘feared for her fillings’. I wouldn’t go that far, but it is an odd – although not unpleasant – dirling feeling (a Scottish word for the vibrating sensation which feels like your teeth are falling out).  And it’s hard. Ms Maclennan runs me through the sorts of exercises you would do at the gym including lunges, triceps dips, squats and biceps curls. The movements are tough for me (my gym membership lapsed several years back), although I’m reasonably fit and run and swim several times a week.  But the joy is that, although it’s hard, each exercise only lasts a minute. In fact, the actual ‘hard’, gym-like bit is over very quickly, in a short 20 minutes. Then there are five minutes of stretches (still quite hard, actually), then the massage, which most people apparently like but I’m not that mad on.  The next day I felt it, really felt it. My muscles ached as though I had done an hour-long workout. Going downstairs was torture and as for lowering myself on to the loo – it took a good few seconds of wincing (a fairly common side-effect, apparently).  After the fourth session, the next-day pain was rather less and I was feeling more energised. The good thing is that it takes considerably less time than going to the gym and having an instructor there keeps you at it and prevents boredom kicking in.  And results so far? It’s certainly no panacea. There was no difference in my weight, or, indeed, in how well my clothes fit, but then it’s early days. I’ve signed up for a few more sessions, so we’ll see how that goes.   I can’t see an effect on cellulite, but then I’m one of those lucky people who doesn’t really suffer from it. And as for an improved sex life? Mind your own business.
Jennifer Trueland

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